Peritoneal dialysis periodically infuses sterile aqueous solution into the peritoneal cavity. Diffusion exchange takes place between the solution and the bloodstream across the natural body membranes. The diffusion removes the waste products that the kidneys normally excrete. The waste products typically consist of solutes like sodium and chloride ions, and the other compounds normally excreted through the kidneys like as urea, creatinine, and water. The diffusion of water across the peritoneal membrane during dialysis is called ultrafiltration.
The inflammation of the peritoneum, called peritonitis, is an undesired complication of peritoneal dialysis. The inflammation may lead to loss of mesothelial cells and the excessive growth of fibrous connective tissue in the peritoneum membrane, called fibrosis. These reactions can lead to the loss of ultrafiltration during dialysis.
In addition, peritonitis may lead to increased protein loss in the patient, with the patient not feeling well enough to eat to replace this loss.
To make up for the reduction in normal ultrafiltration rates, peritoneal dialysis patients experiencing peritonitis often receive hypertonic dialysis solutions, typically containing glucose as an osmotic solute. However, the use of hypertonic solutions for these purposes may be counterproductive. Due to their low pH, high osmolarity, and the presence of glucose, the solutions may inhibit the necessary regeneration of mesothelial cells. They also may lead to the growth of fibroblasts, causing fibrosis.
To enhance the patient's anabolic state and replace protein loss experienced during peritonitis, conventional dialysis solutions also may include mixtures of nutritionally essential amino acids (like methionine, tryptophan, and isoleucine) and nutritionally non-essential amino acids (like glycine and alanine). However, the presence of these amino acids may be counterproductive, too. Many of these amino acids can inhibit the proliferation of mesothelial cells.
Therefore, there is a need for peritoneal dialysis solutions that can be used during and immediately after peritonitis without potentially counterproductive effects. The solutions would promote the replacement of mesothelial cells, minimize the formation of fibroblasts, and counter the attendant loss of ultrafiltration that peritonitis often causes.